This image provides a rare look into a pediatric heart transplant procedure. The recipient in this case is a 13 month-old patient with congenital heart disease (CHD). If you've ever waited to see a specialist in the emergency room, you'll be happy to know that a new app, the so-called "Instagram for doctors" could put a specialist at your doctor's fingertips in minutes rather than hours. The app, called Figure 1, allows doctors around the world to upload anonymous photos of their most compelling (and confusing) cases to a photo sharing platform with goals of trading information and asking for advice. "Images and learning medicine go hand in hand," said Dr. Josh Landy, the app's creator and a doctor in an intensive care unit in Toronto. "Images have been used in medicine to teach and learn for thousands of years." In 2012, while Landy was a visiting scholar at Stanford, he noticed that younger attendants, residents and students were using images to describe and discuss cases they were seeing on a daily basis. "My patients are sick and have complex needs," Landy said. "Often we’ll use images and pictures to communicate what’s going on with those patients. I absolutely recognize the behavior in my own life." Naturally, the primary concern when developing an app that shares medical information was privacy. Landy and his team worked with a lawyer to create safeguards that protect patients' identities, first and foremost by verifying users' credentials. While anyone can download the app, only health care professionals can post images or comment. Other safeguards include vetting photos before they go up and providing all the tools for users to remove identifying details such as faces and tattoos from the images. And before anything can be posted, patients must sign an in-app permission form. "Whenever I’ve asked patients if I can share their photo with other health care providers for educational purposes, people tend to be very receptive," Landy said. And a new feature, called Paging, could benefits patients directly. Using the Paging feature, Figure 1 locates a specialist from the network -- using push notifications -- to give input on the case. The average time for cases solved is 30 minutes, according to Landy. Landy's goals for Figure 1 are lofty. "The big goal is to help democratize medical knowledge," he said. "I want that knowledge to be everywhere in the world where there is Internet signal, because the knowledge of specialists shouldn’t be beyond the reach of the world’s medical community." Here are some striking and informative (read: graphic!) images from Figure 1, below: Purple Urine Bag Syndrome is caused by the conversion of indoxyl sulphate into indigo, a blue colored molecule, by certain Gram-negative bacteria, including Proteus, Klebsiella, and Providencia species. This patient arrived in the ER unsure of why his fingernails had become so dark. His hemoglobin was found to be 22 g/dL and he explained that his skin became itchy after a shower. These findings are typical of polycythemia vera, one of the chronic myeloproliferative diseases, which is characterized by an elevated hemoglobin, pruritus upon bathing, erythromelalgia (red, painful extremities), and thrombosis. This patient’s handwriting shows the progression of Alzheimer’s disease over time. This is a textbook image of Raynaud’s phenomenon. This artificial heart is a fully functional cardiac prosthesis, alleviating the symptoms of end-stage heart failure and the need for immunosuppressive medications. In the past, mechanical artificial hearts limited patient mobility by requiring power from large console-sized machines, but this prosthesis is powered by a portable power source. High lipids, as shown in this image, are a common cause for pancreatitis. This image provides a rare look into a pediatric heart transplant procedure. The recipient in this case is a 13-month-old patient with congenital heart disease (CHD). This x-ray demonstrates a dramatic case of pneumoperitoneum, sometimes called free air under the diaphragm. This finding can be subtle but should always be treated as a surgical emergency. This image provides a rare look into ex vivo lung perfusion (ELVP), an emergent therapy applied to donor lungs to improve organ quality prior to transplantation. Ventilation and perfusion machines used for lung preservation in the past have failed due to the development of tissue edema and increased pulmonary vascular resistance. Ex vivo perfusion uses a special solution which prevents the development of pulmonary edema. In this case, a 3D printed model was constructed from a CT scan of the patient’s fractured skull. The model was used to plan the operation in advance, reducing the length of time needed in the OR. Models like these can also be used to educate a patient about their own injury and recovery. An elderly female patient presented with abdominal discomfort and increasing constipation. A barium study was performed and demonstrated an apple-core lesion. The apple-core sign is most frequently associated with colorectal carcinoma, which results in colonic stenosis. This image shows the creation of a replacement inferior vena cava (IVC) made from the patient’s own veins. This biological graft is used to repair an injury to the IVC segment above the renal veins. Reconstruction can also be performed with the synthetic material polytetrafluoroethylene (Teflon), but research suggests that using biological material may be superior because of increased biocompatibility. Extracranial meningiomas are rare neoplasms which are often misdiagnosed. Clinical presentation includes visual changes, seizures, and spontaneous hemorrhage. This patient had a Thyroglossal Duct Cyst. These cysts often form in childhood and are caused by the cystic expansion of the remnant of the tract that forms as the thyroid gland descends from the tongue base to the neck. Often, these cysts are small, asymptomatic, and go untreated. The specimen pictured here is a rare form of bladder stone known as a jackstone. This variety is referred to as a “jack” stone because of its resemblance to the metal objects in the children’s game, Jacks. Jackstones occur most often in the urinary bladder and less frequently in the upper urinary tract. Source
